2012 Survey of Americans on the U.S. Role in Global Health

The Kaiser Family Foundation 2012 Survey of Americans on the U.S. Role in Global Health is the fourth in a series of surveys designed, conducted, and analyzed by the Kaiser Family Foundation in order to shed light on the American public’s perceptions, knowledge, and attitudes about the role of the United States in efforts to improve health for people in developing countries. The Foundation’s first major survey on this topic was conducted in early 2009, and updates were released in the fall of 2009 and in 2010. This latest survey updates trends from Kaiser’s previous work, and explores in greater detail what the public thinks about the U.S. role in the world, perceptions of spending on foreign aid in general and global health in particular, and the extent to which information may change opinions. We also explore new questions in this survey about how the public views U.S. support for global health compared with that of other donor nations, and perceptions about the potential effects of decreased U.S. funding.

Overall, our survey finds a majority of the American public believes the U.S. has a major role to play in the world, though many remain confused about the size and composition of U.S. foreign assistance. We also find that providing people with accurate information has the potential to move opinion significantly. For example, when survey respondents are told that only about one percent of the federal budget is spent on foreign aid (far less than what most believe when asked to estimate an amount) opinion moves from a majority saying the current level of spending is too high to the public being most likely to say spending is currently too low. And as we’ve seen in the past, people are also more supportive of foreign aid spending when a specific purpose is mentioned—in this case, improving the health of people in developing countries—than they are of the idea of foreign aid in general. Our analysis also shows that even when controlling for other factors, those who possess more accurate knowledge about how much the U.S. spends on foreign aid are more likely to support an increase in U.S. spending on health in developing countries.

Improving health in developing countries is one of many priorities the public sees as important for the president and Congress to address in world affairs, though security concerns, such as limiting the spread of nuclear weapons and fighting terrorism, rise somewhat above other priorities. Within health, basic needs such as providing clean water and reducing hunger, along with improving children’s health, are seen as the top priorities, though every health issue asked about in the survey is seen as important by a large majority of the public.

As has been the case since we began tracking opinion on global health several years ago, most Americans feel that the current level of U.S. spending to improve health in developing countries is either too low or about right. When it comes to the level of U.S. spending, global health appears to be one area where there is more bipartisan consensus than others. For example, while modest partisan differences exist on some aspects of U.S. global health involvement, these differences are much smaller than we find on questions of domestic health care policy and spending. Although Democrats are more likely than Republicans to place a top priority on certain issues within global health, majorities across parties feel that the current level of U.S. spending on health in developing countries is either too low or about right. The lack of deeper partisan divisions may be related to the fact that Americans seem to view global health as a moral issue; while most recognize various potential benefits to the U.S., the top reason people give for the U.S. to engage in efforts to improve health in developing countries is because “it’s the right thing to do.”

However, the public’s support for spending comes with some important caveats. Economic conditions at home make people hesitant to increase spending abroad, with two-thirds saying that given the serious economic problems facing the country and the world right now, the U.S. cannot afford to increase spending on health in developing countries. The public also remains divided on whether more spending will make a meaningful difference in improving health, and is deeply skeptical about how much U.S. money actually reaches people on the ground. Currently, the average American believes that less than a quarter of every U.S. dollar spent on health in developing countries actually reaches those who need it, and that nearly 50 cents of each dollar is lost through corruption.

Most Americans feel that the U.S. is already doing its fair share or more compared to other donor countries, and perhaps related to this, the public prefers multilateral approaches to aid and strongly supports giving through international organizations like the Global Fund to Fight AIDS, Tuberculosis and Malaria, the United Nations, and the World Health Organization. Still, most recognize the important role the U.S. plays, and majorities feel that if the president and Congress were to decrease spending on foreign assistance, there would be an increase in illness and death in developing countries, and that other wealthier countries would not step in to fill the gap. More broadly, the public sees lack of money and resources as a bigger barrier to improving health compared with lack of knowledge about how to treat health conditions in developing countries.

An ongoing challenge for those looking to increase the public’s level of interest in and support for U.S. global health efforts is grabbing the public’s attention in a competitive news environment. Since 2010, the share of the public saying they have heard any information about U.S. involvement in global health issues, as well as reported attention to health in developing countries generally, have both declined. In an election year and one in which the news continues to be dominated by domestic economic problems, garnering public attention for international health issues is likely to continue to be a struggle. One bright spot is that the public expresses at least some appetite for more coverage of these issues, with just over half saying the news media spends too little time covering health in developing countries, up from four in ten in 2010.